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Business name
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Business category
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Hospital
Pharmacy
Clinic
Patent
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Business email
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Business phone
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Directors Name
Please provide your directors name.
Establishment Type
Select Type
Hospital
Pharmacy
Clinic
Patent
Please select your establishment type.
Contact Person
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Contact Phone
Please provide a contact phone number.
CAC License Number
CAC License Number is required for your establishment type.
CAC File
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CAC File is required for your establishment type.
Valid Operating License Number
Valid Operating License Number is required for your establishment type.
License File
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Valid License File is required for your establishment type.
Rep ID
Refer code
State
*
Select State
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LGA
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Select LGA
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Street Address
*
Please provide your street address.
Password
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Confirm password
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